Yuval Levin quotes Peter Suderman on how Obamacare forces policymakers to choose between propping it up and undermining it. I think that’s a byproduct of Obamacare’s fundamental ambition to push us toward universal comprehensive insurance, that is, insurance that pays for routine care. Conservatives, on the other hand, tend to prefer a system with more room for catastrophic coverage: policies that insure against major expenses but leave routine care to be paid out of pocket.

I don’t think the liberal arguments about how markets can’t work in health care are right, but they are right if “work” is defined as “produce universal comprehensive insurance.” Markets aren’t going to do that. To get there requires an extremely tightly regulated and subsidized market, or a government-run system. It requires, that is, Obamacare or something to its left. Comprehensive coverage isn’t viable on a large scale if people who think it’s a bad deal for them can choose something else. So nearly any deregulatory move is going to undermine universal comprehensive insurance: It’s going to make it easier for people to choose something closer to catastrophic coverage.

That’s why bipartisan dealmaking on Obamacare is almost impossible: The parties want to push the health-care system in opposite directions.